Metabolic Syndrome Severity Associated With Sleep Quality in Adolescents With PCOS

sleep quality
Sleepy girl trying to hiding under the pillow on bed.
Metabolic syndrome is associated with poorer sleep in girls with polycystic ovary syndrome and obesity.

Metabolic syndrome is associated with poorer sleep in girls with polycystic ovary syndrome (PCOS) and obesity, according to research results published in The Journal of Clinical Endocrinology & Metabolism.

Poor sleep health has been suggested as a risk factor for the development of metabolic syndrome in women with PCOS. Adolescents with obesity and PCOS have been found to have more disrupted sleep patterns than adolescents without PCOS, but the relationship between sleep and metabolic syndrome status in this age group remains unexamined. Researchers aimed to understand the relationship between sleep health and metabolic syndrome in adolescents with PCOS and obesity using data obtained from the APPLE (Liver and Fat Regulation in Overweight Adolescent Girls study; Identifier: NCT02157974) and PLUM (Post-Prandial Liver Glucose Metabolism in PCOS study; Identifier: NCT03041129) trials.

A total of 30 patients with and 36 without metabolic syndrome (aged 12-21 years; body mass index in the 90th percentile or higher for age and sex) were included in the analysis. A medical history and physical exam were completed at an initial visit and activity and sleep patterns were recorded prior to a subsequent overnight study. Measures of sleep time and efficiency were collected using an actigraphy monitor and a concurrent sleep diary. Hepatic and visceral fat were measured by abdominal magnetic resonance imaging after an overnight fast. A subset of patients (12 with and 9 without metabolic syndrome) was evaluated by polysomnography to characterize their sleep architecture and respiratory patterns.

In patients who received polysomnography, no differences were found in sleep behaviors between the 2 groups, including bedtime, wake time, sleep time, number of awakenings, sleep onset latency, and sleep efficiency. However, a higher apnea-hypopnea index was observed in girls with metabolic syndrome than in girls without metabolic syndrome (6.5 vs 0.7, respectively; P =.02), indicating an increased prevalence of sleep disordered breathing.

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Researchers also found that sleep variables were highly correlated with markers of metabolic syndrome. Lower weekday and weekend sleep efficiency was associated with higher percent liver fat (P =.02 and P =.013, respectively). Lower weekday sleep was also associated with a higher waist to hip ratio (P =.004) and lower weekend sleep efficiency was associated with higher triglyceride levels (P =.04). When analyzed on a per-patient level, the number of metabolic syndrome components increased continuously as sleep risk score increased (P =.04).

The researchers noted that the small study size and subset of patients who received polysomnography may have limited the statistical power of the analyses.

“Among girls with PCOS and obesity, sleep disordered breathing was more prevalent in those with metabolic syndrome, and poor sleep behaviors were associated with metabolic dysfunction and more metabolic syndrome symptoms,” the researchers concluded.

They also noted that these findings are of particular concern because the most recent practice guidelines for treatment of PCOS lack recommendations for sleep screening beyond sleep disordered breathing or in the context of reproductive health. “Our data suggests the importance of comprehensive assessment of sleep health including [sleep disordered breathing] as well as duration, timing, and quality, in adolescents with PCOS and obesity, given the association with [metabolic syndrome] and metabolic dysfunction.”

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Simon S, Rahat H, Carreau AM, et al. Poor sleep is related to metabolic syndrome severity in adolescents with PCOS and obesity [published online January 4, 2020]. J Clin Endocrinol Metab. doi:10.1210/clinem/dgz285